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Intervention and SurgerySession Title: PCI Related Long Term Outcomes

Abstract 17293: Outcomes and Temporal Trends of Percutaneous Coronary Intervention at Centers With and without On-site Cardiac Surgery in the United States

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Abstract

Introduction: There are concerns whether percutaneous coronary intervention (PCI) at centers without on-site cardiac surgery (CS) is safe outside of a tightly regulated research environment.

Objectives: To analyze the outcomes and temporal trends of PCI at centers without on-site CS in a nationally representative population of the United States (U.S.).

Methods: The national inpatient sample was used to identify patients who underwent PCI in U.S. from 2003 to 2012. Hospitals that performed one or more coronary artery bypass graft (CABG) surgeries in a given calendar year were classified as ‘centers with on-site cardiac surgery.’ The primary outcome was in-hospital mortality.

Results: Of the 6.9 million PCI’s performed, 5.7% (n=396,740) were performed at centers without on-site CS. There was a significant increase in the proportion of PCI at centers without on-site CS from 2003 to 2012 (1.8% to 12.7%; ptrend<0.001), reflected across all the indications. Centers without on-site CS performed a significantly higher proportion of PCI for STEMI (34% vs. 20%; p<0.001) compared to centers with on-site CS. Unadjusted in-hospital mortality was lower at PCI centers with on-site CS (1.4% vs. 1.9%; OR, 0.74; 95% CI, 0.72-0.75). After adjusting for demographics, risk factors, hospital characteristics, and procedural indication, there was no significant difference in the in-hospital mortality between centers with and without on-site CS (OR, 1.01; 95% CI, 0.98-1.03; p=0.62). In sub-group analyses, risk-adjusted in-hospital mortality was lower at centers with on-site CS among patients who were ≥75 years (OR, 0.94; 95% CI, 0.90-0.97; p=0.002), had diabetes (OR, 0.94; 95% CI, 0.89-0.98; p=0.007), or prior CABG (OR, 0.83; 95% CI, 0.72-0.96; p=0.01). In-hospital mortality was similar in subgroups stratified by sex, prior MI, history of CHF and CKD.

Conclusions: There was a 7-fold increase in the proportion of PCI at centers without on-site CS from 2003 to 2012 in the U.S with the adjusted in-hospital mortality after PCI being similar at centers with and without on-site CS. This study provides evidence that PCI at centers without on-site CS may be safe for all indications, though certain high-risk sub-groups had lower adjusted in-hospital mortality at centers with on-site CS.